Greg Brown Diabetes and Endocrinology Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney.
Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
J Wound Care. 2023 Apr 1;32(Sup4a):xlvii-lxii. doi: 10.12968/jowc.2023.32.Sup4a.xlvii.
This study aimed to identify potential biomarkers reported in wound fluid of diabetes-related foot ulcers (DRFUs), and their ability to reflect current and prospective wound healing.
A systematic search was executed following the PRISMA methodology across five chosen databases: MEDLINE, Embase, Scopus, Cochrane Clinical Trials and Cochrane Systematic Reviews. Using keywords and phrases, it yielded 5022 results.
Based on predetermined inclusion and exclusion criteria, 19 papers were included in the final analysis, among which: seven reported serial temporal biomarker changes in wounds; six reported measures from baseline and related them to healing rate and/or final healing outcome; four papers reported both end-points, and two papers reported solely on baseline biomarker levels in a generalised diabetic foot ulcer group. Across the studies, a total of 46 distinct markers were described from the wound fluid of n=1141 participants. Biomarkers examined included proteases, protease inhibitors, growth factors, chemokines and cytokines, with proteases being the largest subcategory making up 16 (34.8%) of the markers investigated (n=7). Matrix metalloproteinase-9 (MMP-9) was the most frequently investigated protease and it currently holds the most biomarker promise (n=5). Wound bacterial profiles variably related to wound healing outcome (n=5). One study reported biophysical markers rather than biomarkers, including measurement of wound fluid pH. Study quality was generally good. Drawing quantitative comparisons between papers was not possible due to variability in experimental design including sampling and assessment methods.
These studies collectively indicate several wound fluid measures that could identify DRFU status and outcomes, and that methodological standardisation in the field is needed to determine reliable predictive thresholds for healing.
本研究旨在鉴定糖尿病相关足部溃疡（DRFU）伤口液中报告的潜在生物标志物，并评估其反映当前和预期伤口愈合的能力。
采用 PRISMA 方法，系统检索了 MEDLINE、Embase、Scopus、Cochrane 临床试验和 Cochrane 系统评价这五个选定数据库，使用关键词和短语共得到 5022 项结果。
根据预先确定的纳入和排除标准，最终有 19 篇论文纳入了分析，其中：7 篇论文报告了伤口中连续时间点的生物标志物变化；6 篇论文报告了基线测量值，并将其与愈合率和/或最终愈合结果相关联；4 篇论文报告了终点结果，2 篇论文仅报告了一般糖尿病足溃疡组的基线生物标志物水平。在这些研究中，共从 1141 名参与者的伤口液中描述了 46 种不同的生物标志物。检查的生物标志物包括蛋白酶、蛋白酶抑制剂、生长因子、趋化因子和细胞因子，其中蛋白酶是最大的亚类，占所研究的标志物的 16 个（34.8%）（n=7）。基质金属蛋白酶-9（MMP-9）是研究最多的蛋白酶，目前具有最有希望的生物标志物特性（n=5）。伤口细菌谱与伤口愈合结果呈不同程度的相关性（n=5）。有一项研究报告了生物物理标志物，而不是生物标志物，包括伤口液 pH 值的测量。研究质量总体较好。由于实验设计的变异性，包括采样和评估方法，使得对文献进行定量比较是不可能的。
这些研究共同表明，一些伤口液测量值可以确定 DRFU 的状态和结果，并且该领域需要方法学标准化来确定可靠的愈合预测阈值。
